The Concentration and Persistence of Medical Expenses among Middle-Aged and Elderly Adults: Findings from the China Health and Retirement Longitudinal Survey




Medical expenses, especially among middle-aged and elderly people, have increased in China over recent decades. While the concentration and persistence of medical expenses have attracted great attention, few studies have focused on Chinese residents or vulnerable groups. This study sought to identify characteristics associated with the concentration of medical expenses and estimate their persistence among Chinese middle-aged and elderly adults.


Data was obtained from the China Health and Retirement Longitudinal Study, a nationally representative household survey of middle-aged and elderly adults that was conducted by the National School of Development at Peking University in 2013, 2015, and 2018. Concentration was measured using the cumulative percentages of ranked annual medical expenses and descriptive statistics were used to define the characteristics of individuals with high medical expenses. The persistence of medical expenses and associated factors were estimated using transfer rate calculations and Heckman selection modeling.


Total medical expenses were concentrated among a few middle-aged and elderly adults and the concentration increased over time. Compared with middle-aged and elderly adults in the lower 90% medical expense group, those in the top 10% high medical expense group were more likely to be older, live in urban areas, be less wealthy, have chronic diseases, and attend higher-ranking medical institutions. High medical expenses demonstrated strong persistence. Lagged medical expenses had a persistent positive effect on the incidence and volume of current medical expenses and the effect of a one-period lag was strongest. Individuals with chronic diseases during the lagged period had a higher likelihood of experiencing persistent medical expenses. Factors such as age ≥75 years, income, health insurance, comorbidities, and receiving a higher number of medical services were significant positive contributors to higher medical expenses.


Policy efforts should focus on preventive management and optimizing the allocation of health resources to reduce high medical expenses and inequitable access to health services among middle-aged and elderly individuals in China. The government should establish a more efficient care system and adjust social health insurance policies to alleviate the long-term financial healthcare burden.

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